Meredith Vanstone, PhD; Thanh H. Neville, MD, MSHS; France J. Clarke, RRT; Marilyn Swinton, MSc; Marina Sadik, MA; Alyson Takaoka, MSc; Orla Smith, RN, PhD; Andrew J. Baker, MD; Allana LeBlanc, RN, MScN; Denise Foster, RN; Vinay Dhingra, MD; Peter Phung, MD, MBA; Xueqing (Sherry) Xu, RN, MSN, CCRN; Yuhan Kao, RN, MSN; Diane Heels-Ansdell, MSc; Benjamin Tam, MD, MSc; Feli Toledo, MDiv; Anne Boyle, MD; Deborah J. Cook, MD, MSc
Acknowledgment: The authors thank the patients and families that they had the honor of caring for and appreciate the dedication and compassion of their colleagues in implementing 3WP at these sites.
Financial Support: This study was funded by a grant from the Greenwall Foundation. The UCLA program was partially supported by the California State University Institute for Palliative Care and donations from philanthropists. The St. Joseph's Healthcare program was partially supported by donations from the ICU staff and the Canadian Institutes of Health Research.
Disclosures: Dr. Vanstone, Ms. Clarke, Ms. Swinton, Dr. Smith, Ms. Foster, Ms. Heels-Ansdell, Ms. Toledo, Dr. Boyle, and Dr. Cook report grants from Greenwall Foundation during the conduct of the study. Dr. Neville reports a grant from the California State University Institute for Palliative Care during the conduct of the study. Dr. Cook also reports a grant from the Canadian Institutes for Health Research during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2438.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available from Dr. Cook (e-mail, firstname.lastname@example.org). Statistical code and data set: Not applicable.
Corresponding Author: Deborah J. Cook, MD, MSc, McMaster University, Room 2C11, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5; e-mail, email@example.com.
Current Author Addresses: Dr. Vanstone: McMaster University 100 Main Street West, DBHSC 5003E, Hamilton, Ontario L8P 1H6, Canada.
Dr. Neville: University of California Los Angeles, 43-229 Center for the Health Sciences, BOX 951690, Los Angeles, CA 90095-1690.
Ms. Clarke, Ms. Swinton, Ms. Takaoka, Ms. Heels-Ansdell, and Dr. Cook: McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada.
Ms. Sadik: McMaster University, DBHSC 5th Floor, 100 Main Street West, Hamilton, Ontario L8P 1H6, Canada.
Dr. Smith: St. Michael's Hospital, 4 Cardinal Carter North 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Dr. Baker: St. Michael's Hospital, 300 Bond Street, Toronto, Ontario M5B 1W8, Canada.
Ms. LeBlanc, Ms. Foster, and Dr. Dhingra: Jim Pattison Pavillion, 899 West 12th Avenue, 2nd Floor North, Vancouver, British Columbia V5Z 1M9, Canada.
Dr. Phung, Ms. Xu, and Ms. Kao: University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095.
Dr. Tam: Niagara Health, 1200 Fourth Avenue, St. Catharines, Ontario L2S 0A9, Canada.
Ms. Toledo: St. Joseph's Healthcare, Bishop Dowling Wing, Level 1, Room D-173, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
Dr. Boyle: St. Joseph's Hospital, 50 Charlton Avenue East, Fontbonne Building, 8th Floor, Hamilton, Ontario L8N 4A6, Canada.
Author Contributions: Conception and design: M. Vanstone, T.H. Neville, M. Swinton, O. Smith, P. Phung, F. Toledo, D.J. Cook.
Analysis and interpretation of the data: M. Vanstone, T.H. Neville, F.J. Clarke, M. Swinton, M. Sadik, O. Smith, D. Heels-Ansdell, F. Toledo, D.J. Cook.
Drafting of the article: M. Vanstone, T.H. Neville, M. Swinton, M. Sadik, A. LeBlanc, B. Tam, A. Boyle, D.J. Cook.
Critical revision of the article for important intellectual content: M. Vanstone, T.H. Neville, F.J. Clarke, M. Sadik, A. Takaoka, O. Smith, A.J. Baker, B. Tam, F. Toledo, D.J. Cook.
Final approval of the article: M. Vanstone, T.H. Neville, F.J. Clarke, M. Swinton, M. Sadik, A. Takaoka, O. Smith, A.J. Baker, A. LeBlanc, D. Foster, V. Dhingra, P. Phung, X. Xu, Y. Kao, D. Heels-Ansdell, B. Tam, F. Toledo, A. Boyle, D.J. Cook.
Provision of study materials or patients: T.H. Neville, F.J. Clarke, O. Smith, A.J. Baker, A. LeBlanc, D. Foster, V. Dhingra, X. Xu, Y. Kao, B. Tam, F. Toledo, D.J. Cook.
Statistical expertise: D. Heels-Ansdell, D.J. Cook.
Obtaining of funding: M. Vanstone, T.H. Neville, F.J. Clarke, M. Swinton, O. Smith, F. Toledo, D.J. Cook., D. Foster, D. Heels-Ansdell, A. Boyle.
Administrative, technical, or logistic support: M. Vanstone, F.J. Clarke, M. Swinton, M. Sadik, A. Takaoka, O. Smith, X. Xu, Y. Kao, D.J. Cook.
Collection and assembly of data: M. Vanstone, T.H. Neville, F.J. Clarke, M. Swinton, O. Smith, A. LeBlanc, D. Foster, P. Phung, D.J. Cook.
The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care.
To determine whether this palliative intervention could be successfully implemented—defined as demonstrating value, transferability, affordability, and sustainability—beyond the intensive care unit in which it was created.
Mixed-methods formative program evaluation. (ClinicalTrials.gov: NCT04147169)
4 North American intensive care units.
Dying patients, their families, clinicians, hospital managers, and administrators.
Wishes from dying patients, family members, and clinicians were elicited and implemented.
Patient characteristics and processes of care; the number, type, and cost of each wish; and semistructured interviews and focus groups with family members, clinicians, and managers.
A total of 730 patients were enrolled, and 3407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital administrators. Value included intentional comforting of families as they honored the lives and legacies of their loved ones while inspiring compassionate clinical care. Factors promoting transferability included family appreciation and a collaborative intensive care unit culture committed to dignity-conserving end-of-life care. Staff participation evolved from passive support to professional agency. Program initiation required minimal investment for reusable materials; thereafter, the mean cost was $5.19 (SD, $17.14) per wish. Sustainability was demonstrated by the continuation of 3WP at each site after study completion.
This descriptive formative evaluation describes tertiary care center–specific experiences rather than aiming for generalizability to all jurisdictions.
The 3WP is a transferrable, affordable, and sustainable program that provides value to dying patients, their families, clinicians, and institutions.
Vanstone M, Neville TH, Clarke FJ, et al. Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project. Ann Intern Med. 2020;172:1–11. [Epub ahead of print 12 November 2019]. doi: https://doi.org/10.7326/M19-2438
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Published: Ann Intern Med. 2020;172(1):1-11.
Published at www.annals.org on 12 November 2019
End-of-Life Care, Hospital Medicine.
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